Dr. Carl W. Bushong, known as "Dr. B." to many, is the
originator of a new style of long-distance transsexual and transgender services
having helped hundreds fully transition.
Since the early 1990's, his pioneering efforts broke the mold of the few remaining gatekeeper-style gender clinics by establishing the progressive
Tampa Gender Identity Program which allowed access to a variety of transition services including hormone therapies, electrolysis and guidance to be readily available
under one roof.
Dr. B. continues to innovate by removing the need to travel great
distances for many transition services such as guidance, hormone
therapy, laboratory review and recommendation through his web site,
docbushong.com.

During my
years of work and study with gender folk, I have consistently been
surprised and amazed at both the depth and breath of change that has
occurred during transition. And when I say transition, I am not just
speaking of individuals described (either by oneself or by others) as
“transsexuals,” but also “crossdressers,” “transvestites,”
“transgendered people,” etc.

As I
discussed in my article, What is Gender and
Who is Transgendered, one’s Gender Identity is only one of our
five semi-independent aspects of gender (Genetic, Physical, Brain
Gender, Brain Sex and Gender Identity). One’s Gender Identity is
established early in childhood and is our Self Map. Gender identity is
one's subjective sense of one's own sex. Like pain, it is unambiguously
felt but one is unable to prove or display it to others. One's
subjective gender is just as real and more immalleable than one's
physical gender but unfortunately not recognized in our culture. This
internal map forms how we see ourselves as a sexual individual (our
affiliation to a gender), just as Brain Sex is our Love Map—how we
identify our love/sex partner.

When our
gender Self Map does not match our Physical Gender (genitals), along
with our society providing no niche or role (although most other
societies do) for this varied gender expression, a conflict usually
develops. Although gender folk’s combination of the five gender
factors is just as natural as any other, it is not perceived as “normal”
(what you are supposed to be or do) in our society.

Because a
child’s greatest desire is to be normal (like everybody else), they
create an artificial self which meets this goal. They are often so
successful at this that they not only fool everyone else but themselves
as well — at least part of the time, in some way.

I have
gradually come to the conclusion that for most physically male gender
folk, the male persona is an artificial construction produced by the
early adolescent individual (ages 12 to 15) in order to fit in and be
like everybody else. For the physically female person, there is a
separate and different, but still consistent pattern, which I will
address in a separate writing.

Once
created, physically male gender folk live in this role — a 3-D
personality with its own goals, likes and dislikes, values, hobbies,
etc. Although indistinguishable from the “real thing,” it isn’t
themselves. It is an artificial creation for them to be able to fit in.
But, as the nagging reality of the deception becomes harder and harder
to suppress, one has to express their true self somehow, in some way.

For most,
dressing is the obvious compromise. If one cannot be female, one can at
least express femininity. But the more one expresses one’s true self,
the desire for more becomes greater. Some individuals continue
expressing themselves more and more, others panic and purge only to
start again later.

One's
transgender classification (crossdresser, transgenderist, transsexual,
etc.) is due to how each individual adjusts to first, the conflict
between their natural female subjective gender (Self-map) and their need
to be “normal,” and later to how and how much they resolve the
conflict between their female subjective gender and their “male
persona.” There is no objective “best solution,” only a
subjective, personal best solution, which may change over time.

After
years or decades of living, working and building within their male
persona, it is often too “expensive” to give up the life, perks,
family, etc., one has built up—in order to go back to basics and have
an emotionally 12 year old girl grow up—and live in a once male 40+
year old body.

Therefore,
while all gender folk need to transition, not all need to use hormones,
let alone surgery. The only person who truly knows where and how far
to go is the transgendered person, themselves. But even they cannot do
it alone. When one has spent decades fooling everyone, including
oneself, it is difficult to tell what is true and what is smoke and
mirrors. As we need a reflection to see our own face, we need a
knowledgeable, experienced helper to see our true self.

How does
one find such a helper? —With great difficulty, I’m afraid. In my
opinion, a psychotherapist’s role is to be a helper, a teacher, and a
guide. To help the transgendered with those areas and conflicts
resulting from a lifetime of living a double life, one inside or hidden
from others, one out in public. The therapist needs to be a teacher in
making available all the accumulated knowledge, skills and choices one
has as well as clearing away the myths, lies and misinformation. And as
a guide, the therapist aids the client through the social, legal,
medical and emotional mine fields toward one’s true self. Here
are some must have’s you will need to find in your helper.

1. Is
your helper knowledgeable and up-to-date about transgender needs and
problems?
2. Has your helper previously helped at least two other people
transition successfully before you?
3. Is your helper knowledgeable about electrolysis, hormones, surgery,
transgender law, etc., to guide you through your transition?
4. Does your helper know and understand the difference between
transitioning and psychotherapy.
5. Last but not least, does your helper have a working relationship with
other knowing, experienced and successful practitioners such as
electrologists, endocrinologists, surgeons, attorneys, etc.

While
gender folk have problems and need psychotherapy, and marriage and
family counseling like any other group, transitioning, itself, is not
psychotherapy. Transitioning is being given the tools and knowledge
to ask the questions whose answers set them free. The old artificial
male persona falls away piece by piece, revealing underneath a brand new
self. The new self may be female or just more feminine. Whatever
transitioned people may appear to others, to themselves they are happy,
and sometimes for the first time, whole individuals.

I am
pleased to say that those who have stayed to complete their transition
with me have all become both happy people and very happy with their
decision to transition. Never have I had so many people use the word “giddy”
to describe themselves and their new life.

However
far one is able to go toward dismantling the male persona and allowing
their naturally female subjective gender to develop, one generally seems
to have the following three levels of transition:

1. Recognition
that one's Brain Gender is different from one's Physical Gender
—This first phase comprises the majority of transgendered persons (75
– 95%) and can take the form of seeing one's self as a "woman
trapped in a man's body," a need to express one's "feminine
side," etc. This stage is mainly concerned with physical/surface
changes such as crossdressing, passing, makeup, wigs, etc. In this first
part, many gender folk don't even venture from their own home in female
attire or restrict their expression to undergarments (bra, panties) in
public. They often have a juvenile (before age 15) and later, an adult
phase. There is often years or decades between the two phases. This
level is filled with confusion, conflict, guilt, panic, and purging. The
so called "Primary Transsexual" is an individual who never
constructs a male persona and therefore never accepts their male
genitals or challenges their female Self Map/subjective gender.

2. Accepting
one's True Self— This stage is much more varied than the
first, and has less emotional turmoil. This is the stage where one
begins to accept their female self in some way and to make lifestyle
changes to accommodate this acceptance. One may only accept the need to
appear female, still denying their female true self (crossdresser) or
begin to accept their true female self, but concentrating on a
superficial physical level of change (transsexual, transgendered).

The
self-identified crossdresser may begin to bring his significant other
into his dressing, begin going to crossdresser meetings and events, or
even going out into public. Those individuals more accepting of their
true self will start to look for help in physical transitioning, such as
hormones, electrolysis, and surgery, as well as wigs, makeup and
clothes.

The major
insight lacking at this stage is that they are still under the control
of the male persona with all of its unnatural fears, drives,
expectations, and knowledge. Even their view of their "female
self" is his view, not their freed and autonomous female
self. They are still trapped in the belief that physical form alone
determines gender.

3. Becoming
one's True Self — This is the last but unfortunately least
experienced part of transitioning. This is the stage when that little
girl trapped inside an artificial male persona in order to fit in,
breaks free, grows up and has her own life — often with markedly
different values, temperament and interests.

It has
been my observation that the female subjective self needs little help in
growing up and developing if the overpowering weight of the male persona
is removed from it. The individual has spent years, decades developing,
reinforcing and living in this male role. Dismantling the male persona
takes a great deal of time, effort and outside help. In those
individuals identified as "transsexual," their subjective
sense of happiness and success is directly parallel with the degree they
have dismantled their male identity, not on their age, physical size,
hormones, surgery, etc. Another interesting aspect of a female
subjective gender with a male physical gender is the concept of Sexual
Orientation. To classify a M/F individual as either homosexual or
heterosexual would be equally false. If one views their gender as that
established by their subjective gender, then having sex with a physical/
subjective female would make them homosexual (lesbian). But, if one
viewed their actions from their physical gender, they would be
committing a heterosexual act. In other words, no matter which gender
they have sexual relations with, they are simultaneously committing both
a homosexual and heterosexual act. (See What
is Gender and Who is Transgendered for details.)

Informed
Choice

My method
for transitioning I term “Informed Decision Making.” In this, the
client makes their own decision to go down whichever road they choose
and how far, upon being given the information and insight needed to do
so. I find most gender folk focus on their dress and body at first not
realizing that the whole persona changes during successful
transitioning. This is why physical transitioning (clothes, makeup,
hormones, surgery) is only a minor part of the whole transition process.
Values, lifelong hobbies, musical tastes, temperament, and goals, can
and often do change. The new self which emerges from under the male
personality often grows into a person no closer to the male persona than
a sister. It is often a rebirth in slow motion (it takes one to two+
years). One becomes their true natural self, which is far greater than
just a change in physical gender.

But,
while transitioning offers great promise, there are also great dangers
if one does not use care in choosing who they listen to and ask for
help. All too often individuals in transition, or for that matter,
those who feel they have arrived, become a collection of disparate
traits and cosmetic changes instead of a complete package. Naturally,
some individuals are stubborn and refuse to accept any guidance and
support. But the real culprits that hold many from achieving their best
are often the treating professionals themselves.

Many
times providers remain ill informed about transgender issues or worse,
remain uncaring and expect the transgendered client to fend for oneself.
They never aid or foster an informed consumer’s mind-set. Who’s best
interest is served when a provider is often unprepared to provide the
client with the broad based understanding needed to make the proper
choices?

If an
individual happens upon “professionals” who offer no guidance or
sense of priority while making available hormones or surgery with little
or no life-style preparation — a disaster may be in store. The
individual’s future happiness is threatened when the outcome of such
“professional” intervention may be a bearded, baritone post-op lady
with large breast implants but little or no training or understanding of
how to walk, talk, or sit, let alone a strong sense of “female-self.”

In an
area such as gender, where myth and ignorance often exceed knowledge
within the professional community, it is only expected that the lay
persons in need should be confused, frustrated, and uninformed. The
transgendered often begin life feeling as if they are the only person in
the world to have such a problem; that something is wrong with them -
and not just in society’s view. When at last they try to be
themselves, to throw off sometimes decades of deception, frustration and
denial, they are often both fearful and resentful. So much of their life
is felt to be “lost,” and naturally there is an eagerness to get on
with their “new self,” right now! Unfortunately, many gender folk
have collected a lot of “excess baggage” in the form of a marriage,
family, children, and educational/professional development that doesn’t
properly translate to one’s desired gender status. And just like
society as a whole, the transgendered individual may focus far too much
on the physical aspects of gender, down-playing or even missing the
mental, behavioral, social and emotional aspects. Their male persona is
not realized or appreciated, let alone its need to be dismantled.

When it
comes to gender, our culture is genitally obsessed. What’s between
your legs and on your chest determines your gender (sex). Body form and
plumbing are all our society sees and therefore all the transgendered
person may be aware. Actually, most conventional wisdom regarding sex
and gender is incorrect. (See What is
Gender and Who is Transgendered for details.)

The most
important service a professional can provide for the transgendered
individual is to provide the knowledge, support and resources needed for
a series of “informed choices” as to what, how and where their
transformation will take them.

Today
quality gender based services are becoming increasingly available,
although they are still geographically spotty. While some regions of the
country are very “gender knowledgeable,” others are not so gifted.
Even in areas with minimal professional services available, the dynamism
that a conscientious and self-aware gender support group can provide is
tremendous. But sometimes support groups and Internet “chat rooms”
can be counterproductive, if the blind are leading the blind. All too
often those with the least knowledge and most misinformation are the
most eager to share their “insights”—not as an opinion, but as “fact.”
When a transgendered individual who is new to the community comes across
these self-appointed experts, they are often swayed by this mis- and
dysinformation. Even with the gender community’s growing size,
knowledge base and opportunities, groups of individuals suffering from
the consequences of misinformation and the quick-fix mentality are
living in a small world of their own—still trying to influence others
along the same ill-fated path. Group knowledge, resources, and a desire
for personal growth are essential. While the transgendered now can take
a long overdue control of their destiny, one should keep in mind that
success is heightened by “informed choice,” not just choice.

Counseling,
though, need not be weekly. In fact, very few of my clients receive
weekly sessions after the first few months. Of course, the more
intensive the effort, the quicker one will reach their goal. But
counseling more than once a week doesn’t seem to help — unless there
is more than one problem being worked on, such as transitioning plus
marriage problems.

For
example, let’s say Mary (who was Bob) has recently come to accept she
is transgendered, and has a wife, Betty, who she cares for, and three
children ages seven, nine, and twelve. Mary is a successful engineer at
a large company making a very good wage. Her wife does not work outside
the home.

Mary has
several problems to solve. One — what does “transgendered” mean to
her? Two — how does she now relate to her wife who is fearful and
upset? Three — how, when and what to tell the children? Four — what
should she do about work, friends, family, etc.?

The first
problem is part of transitioning and by far the most important. As Mary
answers, “What does being transgendered mean to me?,” the solution
to her other questions will become clearer and clearer. But at some
point, as Mary gets to know and accept herself more, she and Betty will
probably benefit from couple/marriage counseling as there are many
issues between them they need to resolve.

Because a
person’s core personality often changes greatly during transition,
making too many decisions too soon is a mistake. At the beginning of
transition, Bob’s values, goals and baggage (personal
responsibilities, etc.) are still in charge — at this stage Mary is
only a gleam in Bob’s eye. It takes time to tear down the walls
and fill in the gaps. As Mary is learning and growing, Betty needs to be
brought along too — at least as far as she is willing or capable of
going. Remember, this a very trying time for the spouse as well as the
transgendered person. The partner’s whole life is being turned upside
down and she has no control over it. The partner often feels betrayed,
angry and frustrated. Betty can even see Mary as her enemy, her
competition. But, the more and the sooner a knowing, experienced
professional is brought into the picture, the easier it is for both
parties, and the better the outcome for everyone. Betty’s willing
cooperation is needed for best dealing with the children, family, and
future living arrangements.

With
Betty brought into the process, as Mary’s transformation continues
they can decide as a couple what their relationship and living
conditions will be. Not always, happily, but truthfully with everyone’s
needs acknowledged and discussed.

If Mary
realizes she must transition fully into a female body and role, they are
now positioned to deal with this together including the telling of
children, family and friends. Often a completely new job description is
called for upon transition — sometimes because of the difference in
Bob’s and Mary’s personality and values, and other times because a
woman is not as accepted or respected in the old employment. And, of
course, sometimes the prejudice of the employer leads to a loss of job.
But, I have found that prejudice is the least common reason for job
change if the transition is done correctly on all levels — emotional
and psychological as well as physical. In fact, over the last few years,
I have experienced very few negative reactions from employers, family
and friends towards my transitioning gender clients. So few that I have
began to feel that most negative reactions stem from gender folks not
being given good help during transition rather than the transition
itself. The exceptions to this rule are often spouses and best friends,
because in both cases, the very basis of the relationship are often
threatened by transitioning.

There
is a global need for all gender folk, whether CD, TV, TS or TG to
transition, although the road taken and the distance traveled may vary
greatly from individual to individual. Transitioning is much more
than a physical/superficial journey. And transitioning in itself is not
psychotherapy but a rebirth of an individual long buried under the
layers of society’s imposed expectations. Like all births, it can be
long, difficult, very painful and full of doubts at times. But who can
deny the joy and expectation of a new life, a new beginning, even if the
death of the old is needed to give room for the birth of the new?

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